Growth of HIV-exposed uninfected, compared with HIV-unexposed, Zambian children: a longitudinal analysis from infancy to school age

Abstract

BackgroundEarly growth of HIV-exposed, uninfected (HEU) children is poorer than that of their HIV-unexposed, uninfected (HUU) counterparts but there is little longitudinal or longer term information about the growth effects of early HIV exposure.MethodsWe performed a longitudinal analysis to compare growth of HEU and HUU infants and children using data from two cohort studies in Lusaka, Zambia. Initially 207 HUU and 200 HEU infants from the Breastfeeding and Postpartum Health (BFPH) study and 580 HUU and 165 HEU from the Chilenje Infant Growth, Nutrition and Infection Study (CIGNIS) had anthropometric measurements taken during infancy and again when school-aged, at which time 66 BFPH children and 326 CIGNIS children were available. We analysed the data from the two cohorts separately using linear mixed models. Linear regression models were used as a secondary analysis at the later time points, adjusting for breastfeeding duration. We explored when the main group differences in growth emerged in order to estimate the largest ‘effect periods’.ResultsAfter adjusting for socioeconomic status and maternal education, HEU children had lower weight-for-age, length-for-age and BMI-for-age Z-scores during early growth and these differences still existed when children were school-aged. Exposure group differences changed most between 1 and 6 weeks and between 18 months and ~7.5 years.ConclusionsHEU children have poorer early growth than HUU children which persists into later growth. Interventions to improve growth of HEU children need to target pregnant women and infants.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-017-0828-6) contains supplementary material, which is available to authorized users.

Birthweight, HIV exposure and infant feeding as predictors of malnutrition in Botswanan infants

“…The prevalence of undernutrition in the present study was higher in HEU infants compared to HUU infants during their first 1000 days. This is consistent with findings from a number of studies conducted in Zambia, Kenya, South-Africa, Uganda and Tanzania, which have demonstrated that HEU infants have poor growth compared to HUU infants (9,12,20,38,39) . A study in Kenyan infants found that HEU infants had poor nutritional Table 2 Feeding practices of infants by HIV exposure from selected districts in Botswana.…”

“…Without PMTCT strategies, HIV transmission from mother to child could be as high as 25% . However, this success has resulted in the increase in the population of HIV‐exposed but uninfected (HEU) infants . Health and/or nutritional issues unique to HEU infants will have major population health implications as their numbers increase .…”

“…However, in sub-Saharan Africa, mortality of children aged <5 years still remains higher at 86 deaths per 1000 live births (1) . Mortality in children aged <5 years is mainly attributed to undernutrition, with 45% of these deaths being preventable through optimal increase in the population of HIV-exposed but uninfected (HEU) infants (9,10) . Health and/or nutritional issues unique to HEU infants will have major population health implications as their numbers increase (11,12) .…”

The effect of the subclinical small ruminant lentivirus infection of female goats on the growth of kids

“…The theoretical rationale for hypothesizing the link between the mother's infection and kid's growth is based on some observations made over last decades in pregnant women infected with human immunodeficiency virus (HIV) which is a close relative of SRLV. The growth of HIV-exposed but uninfected children seems to be impaired, mainly in the first 12-24 months of their life [18][19][20][21]. Pathogenesis of this phenomenon is not clear with a chronic immune activation in response to prolonged prenatal HIV exposure [22] or an exposure to antiretroviral drugs in utero and postnatally during breastfeeding [23] being the most likely culprits.…”

Lower Birth Weight-for-age and Length-for-age Z-scores in Infants With in-utero HIV and ART Exposure: A Prospective Study in Cape Town, South Africa

“…Several studies have shown that infants who are HEU experience poorer growth, health and survival outcomes compared with their counterparts, infants who are HIV-unexposed (HU) [2][3][4][5][6][7]. Some studies have shown that fetal growth, measured by an infant's birth weight and length may be affected by in utero antiretroviral (ARV) exposure [6,[8][9][10]. Many studies demonstrated that in utero fetal exposure to HIV and ARVs is associated with adverse birth outcomes such as preterm birth, low birthweight and small-for gestational age [11][12][13][14][15].…”